CQI

Continuous Quality Improvement (CQI, also called Quality Assurance / Quality Improvement, or QA/QI) is an integral part of any EMS system. It helps to ensure that patients receive quality care and, if any deficiencies exist, provides a mechanism for gently correcting providers who need it. Most commercial services have some sort of CQI infrastructure in place, either through the medical director or through personnel tasked to the job, and this is an area in which college EMS services should not be complacent either.

When selecting a CQI coordinator, your service's medical director is the first person to ask. It's possible, though, that he may not be willing to take on the additional responsibility of regular CQI work. And in the small college setting, there may not be many other physicians on campus whom you can approach (the student health service would be your best bet here). If that's the case for your service, it's time to start thinking creatively.

Is there a local ambulance service that might be willing to take on CQI responsibilities for your squad? What about alumni of your service that are still in the area? If worst comes to worst, you can appoint a senior, experienced active member of your squad to do the job. When picking your CQI coordinator, keep in mind that you want someone with EMS experience who is familiar with your system. (This may rule out your medical director in some instances, but he's still a physician, and you're practicing under his license, so he gets first crack. But that doesn't mean you can't enlist someone who is active in EMS as well.)

Lastly, keep in mind that CQI is never supposed to be punitive. The purpose of the program is to make sure that your providers are delivering quality care. When deficiencies are exposed, the goal is to remediate the provider(s) in question, not punish them. For this reason, the effective CQI coordinator always remembers that he and the providers under his watch are on the same team and working toward the same goal.

Expanding Your EMS Horizons

On a college squad, you've either worked as a quick response service, or perhaps as a transporting service. Maybe you also have worked with a local fire department or a commercial ambulance company back home or as an internship. These are all great ways to use your EMS training and learn and meet people.

But there are more places to turn that offer different types of EMS experiences and training, along with providing great networking opportunities. In this post, I'll focus on disaster medicine. Disasters call for large numbers of EMS resources, but also additional training and often using a different model of care.

There are many organizations that you can volunteer with (and/or work for) that provide disaster medical services. I won't try to list them all, but lets focus on the two that I work with (feel free to add more in the comments).

The Metropolitan Medical Response System (MMRS) has teams in most states which are funded by grants from Homeland Security (via FEMA). These teams are staffed by volunteers and are usually under the control of the state's emergency management office (or similar entity). They respond to mass casualty incidents mostly within their state. FEMA describes the goals as such (you can read a detailed document also):

The MMRS program supports the integration of emergency management, health, and medical systems into a coordinated response to mass casualty incidents caused by any hazard. Successful MMRS grantees reduce the consequences of a mass casualty incident during the initial period of a response by having augmented existing local operational response systems before the incident occurs. (FEMA HSGP)

I have found my MMRS team to be a dynamic group of people (EMTs, nurses, doctors, non-medical administrators, communications experts, etc) that has provided great networking. Furthermore, each MMRS team has trainings that you otherwise don't have access to (at least easily or for free). Plus, the best part is that you are contributing your assistance in a meaningful way when an emergency occurs.

The second organization is similar to MMRS, although with a different focus, and on a larger scale. The National Disaster Medical System has a variety of teams, such as the Disaster Medical Assistance Teams (DMAT). These teams are located nationwide and take turns being on call for a month per year to deploy to locations nationwide or internationally for two week deployments in support of medical operations. DMAT members are federal employees under the US Dept of Health and Human Services, so the approval and training takes a while and the teams require significant commitment. If you deploy, your regular job is protected and you are paid for deployment time. Most importantly, you are working with an extremely talented team of professionals responding to some of the worst natural disasters, etc.

The National Response Framework utilizes the National Disaster Medical System (NDMS), as part of the Department of Health and Human Services, Office of Preparedness and Response, under Emergency Support Function #8 (ESF #8), Health and Medical Services, to support Federal agencies in the management and coordination of the Federal medical response to major emergencies and federally declared disasters including:
* Natural Disasters
* Major Transportation Accidents
* Technological Disasters
* Acts of Terrorism including Weapons of Mass Destruction Events
(NDMS)

College (EMS) Confidential

I was part of the team that designed and implemented the on-call EMS response program for my school, and one concern the administration voiced surprisingly frequently was that of privacy.

The Health Insurance Portability and Accountability Act (HIPAA) forbids, among other things, the unauthorized release of patients' protected health information. HIPAA applies to all on-duty EMS personnel, regardless of their age or unit affiliation. Many college administrators are not familiar with HIPAA--or at least with its application in the EMS setting--so their confusion is understandable.

The college EMS agency has the responsibility to educate the administration and assuage their privacy concerns. Seeing as college campuses are essentially small cities where word travels quickly, the consequences of a privacy violation could be devastating. The administration, and the student body, needs to know that confidential health information will be kept confidential.

For this reason, it's a good idea to conduct an annual or even semi-annual HIPAA training with your members. You may even wish to open the session to the campus community, so they can see what the EMS privacy guidelines are. (And it goes without saying that PCRs and other sensitive records should be kept securely.) Patient privacy is a priority for us, and the better the students and administration understand that, the easier it will be to earn their trust and confidence.

EMS: College to Career

I arrived at college as a brand-new EMT-B. Throughout my undergraduate years I was active with the campus EMS squad during the term and with my hometown 911 transport agency during school breaks. Following my graduation, I worked for a private ambulance company for the summer and then moved to Buffalo for paramedic school. A year later, I have begun working as a paramedic. The lifeblood of my fledgling career may have been my time with urban and commercial services, but its backbone was definitely my four years of college EMS. That time was a jumping-off point that has greatly aided my transition to "real" EMS jobs.

For starters, experience is king. There is obviously a minimum level of training required to function in any EMS capacity, but beyond meeting "cognitive" and "psychomotor" certification standards, one of the chief distinguishing features between adequate, good and great EMS personnel is the experience they bring to the table. Collegiate EMS offers its members the opportunity to take calls, treat patients and practice skills. Any experience is good and more the better. Plus, college squads are often less complicated to join than private or municipal agencies.

Secondly, I learned a great deal about "behind-the-scenes" EMS while at college. In two years as Equipment Officer and two years as Operations Officer, I was closely involved with inventory, purchasing, communications, scheduling, training, personnel and inter-agency relations. This provided me with a more encompassing view of the industry that didn't end at the ambulance doors. College EMS is unique in that members can execute a wide variety of offices and responsibilities and do so much more quickly than could be expected in the commercial world. Any college student considering becoming an EMS professional would be well advised to seek office with his campus squad at some point during his (or her) time there.

Lastly, EMS isn't for everyone. Some people are born to do this job; most of us have to work at it. But there are also some people who are destined for greatness in other areas. If you are interested in EMS--in whatever capacity--the only way to know into which category you fall is to try the work. College EMS is the perfect way to do just that.

Training and Engagement in Your College and Community

We know, and hopefully all agree, that training is vital to aquiring and maintaining EMT skills. But all-to-often I notice squad training just internally, or perhaps with just the fire department in their town, etc. So I wanted to put together a list, and invite others to add to it, of departments that may exist within your college, or municipal/private services in the community, that are groups to consider training with. You will notice that I have also tagged this post as "public relations," because training with other departments will almost certinally enhance their view and opinion of your group.

Creating Great EMTs

The fact is, unfortunately, that it is very difficult to create great all-around EMTs if their only exposure to EMS is on a college campus. Here is why I think this, and I hope that someone can suggest a way to overcome some of the issues I will point out here.

Welcome

Hi all,
The goal of this blog is to be a useful resource to EMS groups working on college campuses. Topics will include operations, funding, organization, and administration. Operationally, college EMS squads have to deal with a different set of common calls than your average city or rural 911 unit may handle. Funding is done through different sources, and often at a lower level then outside EMS groups, especially if the college service does not bill for services. Other issues appear as college EMS groups, especially new ones, work to get respected and recognized in their communities.
In this blog, I hope to combine my experience in this area with that of other EMTs who have worked in this area. If you are interested in contributing knowledge, please let me know. Any and all feedback is welcome.
I hope that this blog proves to be a valuable resource for the Collegiate EMS community!
Sincerely,
Ryan